SUPERVISOR OF SPECIALTY RX at HealthSmart in Irving, Texas

Job Description:

About HealthSmart

HealthSmart is the premier provider of customizable and scalable health plan solutions for self-funded employers. We reduce costs and improve outcomes, all the while treating our health plan members with dignity and respect. But that's just the beginning of our story - We make differences in peoples' lives every single day!

Our HealthSmart team understands the difference we make when treating others with dignity and respect, which is why we embody our mission by promoting a diverse and inclusive culture.

We're a company of innovators.

We deliver health benefit plans and solutions to provide worry-free, self-funded plan administration, quality coverage, and innovative care.

We provide care management services that change lives and helps employers and members take control of healthcare costs.

HealthSmartRx Solutions delivers extremely attractive pharmacy benefits with an Rx discount program.

Our Network Solutions group offers national, comprehensive provider networks to provide member access to the right care.

HealthSmart Casualty Claims Solutions leverages technology, robust information and unmatched experience to deliver innovative casualty claims management solutions with outstanding results.

We offer business intelligence and web-based reporting. Plus, we offer a variety of health and wellness initiatives and even onsite employer clinics.

POSITION SUMMARY
At HealthSmart, the Medical Supervisor of Specialty Rx will lead the team of Financial Assistance Patient Advocates by planning, directing and overseeing the operations to execute savings goals. This role assists the team in daily operations including the development, analyses and implementation of staffing, training, and reward/recognition programs.

Essential Skills

• Experience managing complex reimbursement/financial assistance medical claims


• Specialty Pharmacy financial assistance


• In-depth knowledge of Patient Assistance Programs


• Supervisory/management experience


• 5 years of experience in a healthcare related field preferred


• Ability to work flexible schedule between 8am-8pm

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

• Manage Specialty Rx Financial Assistance team by planning, directing and overseeing the operations and savings goals


• Work with the team to include the development, analyses and implementation of staffing, training, and reward/recognition programs


• Make daily decisions and use sound judgment on the work processes


• Build relationships by communicating frequently with professional medical personnel (doctors, nurses, pharmacists, pharmacy technicians, pharmacy buyers, patient financial advocates)


• Gain support and compliance with program through successful relationship building


• Engage in proactive communications with drug manufacturers and financial assistance organizations about their assistance programs to recover further savings for HSRx's customers


• Effectively respond to escalated issues from customers and manufacturer PAP programs


• Understand the current 50+ manufacturer programs, 2000+ drugs and strengths included in the PAP programs


• Remain current with the application/enrolment process regarding qualifying criteria and other processes to maximize the program efficiencies


• Responsible for month end savings report for each customer to support fee billing to clients.


• Basic understanding of medical claim workflow


• Knowledge of how to read and interpret a Medical Explanation of Benefits (EOB)


• Fluent in the application of medical benefits based on plan document provisions


• Consistently meet or exceed quality and production standards set forth by management


• Monitor and follow up on pending claim activity timely and accurately


• Assist manager with ad-hoc reports and projects as needed

Physical Requirements

• While performing the duties of this job, the employee is frequently required to sit, talk, and hear.


• The employee is occasionally required to walk; use hands and fingers to feel, handle, or operate objects, tools, or controls; and reach with hands and arms.


• The employee must occasionally lift and/or move up to 30 pounds.


• Specific vision abilities required by this job include close vision and the ability to adjust focus.


• The work is performed primarily in an office setting.


• The noise level in the work environment is moderate
  

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position

HealthSmart provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.